American Journal of Preventive Medicine (AM J PREV MED )

Publisher: American College of Preventive Medicine; Association of Teachers of Preventive Medicine, Elsevier


The American Journal of Preventive Medicine is the official journal of the American College of Preventive Medicine and the Association of Teachers of Preventive Medicine. It publishes articles in the areas of prevention research, teaching, practice and policy. Original research is published on interventions aimed at the prevention of chronic and acute disease and the promotion of individual and community health. Of particular emphasis are papers that address the primary and secondary prevention of important clinical, behavioral and public health issues such as injury and violence, infectious disease, women's health, smoking, sedentary behaviors and physical activity, nutrition, diabetes, obesity, and alcohol and drug abuse. Papers also address educational initiatives aimed at improving the ability of health professionals to provide effective clinical prevention and public health services. Papers on health services research pertinent to prevention and public health are also published. The journal also publishes official policy statements from the two co-sponsoring organizations, review articles, media reviews, and editorials. Finally, the journal periodically publishes supplements and special theme issues devoted to areas of current interest to the prevention community. For information on the American College of Preventive Medicine (ACPM) and the Association of Teachers of Preventive Medicine (ATPM), visit their web sites at the following URLs: and

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    American Journal of Preventive Medicine website
  • Other titles
    American journal of preventive medicine
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    Periodical, Internet resource
  • Document type
    Journal / Magazine / Newspaper, Internet Resource

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    • Publisher's version/PDF cannot be used
    • Articles in some journals can be made Open Access on payment of additional charge
    • NIH Authors articles will be submitted to PubMed Central after 12 months
    • Publisher last contacted on 18/10/2013
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Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: Despite the health benefits associated with smoking cessation, continued smoking and relapse following cessation are common. Physical activity is associated with reduced risk of cardiovascular disease in general, though less is known about how increased cardiorespiratory fitness (CRF) may influence cardiometabolic risk among smokers. Strategies are needed to protect against the health consequences of smoking among those unwilling or unable to quit smoking. Purpose: To determine whether greater CRF was associated with reduced metabolic risk among smokers. Methods: The prospective influence of estimated CRF (i.e., maximal metabolic equivalents) on the development of metabolic syndrome and its components were examined among adult smokers (N=1249) who completed at least two preventive medical visits at the Cooper Clinic (Dallas, Texas) between 1979 and 2011. Statistical analyses were completed in 2013 and 2014. Results: The rate and risk for metabolic syndrome, as well as abnormal fasting glucose and HDL cholesterol levels declined linearly with increases in CRF (all p's<0.05). Smokers in the moderate and high fitness categories had significantly reduced risk of developing metabolic syndrome and elevated fasting glucose relative to smokers in the lowest fitness category. In addition, smokers in the high fitness category were less likely to develop abnormal HDL cholesterol levels. Conclusions: Moderate to high CRF among smokers is associated with a reduced likelihood of developing certain cardiovascular disease risk factors and metabolic syndrome.
    American Journal of Preventive Medicine 01/2015;
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    ABSTRACT: Background: Fifty years after the first Surgeon General’s report, tobacco use remains the nation’s leading preventable cause of death and disease, despite declines in adult cigarette smoking prevalence. Smoking-attributable healthcare spending is an important part of overall smoking attributable costs in the U.S. Purpose: To update annual smoking-attributable healthcare spending in the U.S. and provide smoking-attributable healthcare spending estimates by payer (e.g., Medicare, Medicaid, private insurance) or type of medical services. Methods: Analyses used data from the 2006–2010 Medical Expenditure Panel Survey linked to the 2004–2009 National Health Interview Survey. Estimates from two-part models were combined to predict the share of annual healthcare spending that could be attributable to cigarette smoking. The analysis was conducted in 2013. Results: By 2010, 8.7% (95% CI¼6.8%, 11.2%) of annual healthcare spending in the U.S. could be attributed to cigarette smoking, amounting to as much as $170 billion per year. More than 60% of the attributable spending was paid by public programs, including Medicare, other federally sponsored programs, or Medicaid. Conclusions: These findings indicate that comprehensive tobacco control programs and policies are still needed to continue progress toward ending the tobacco epidemic in the U.S. 50 years after the release of the first Surgeon General’s report on smoking and health.
    American Journal of Preventive Medicine 12/2014;
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    ABSTRACT: Background: In 2012, CDC launched the first federally funded national mass media antismoking campaign. The Tips From Former Smokers (Tips) campaign resulted in a 12% relative increase in population-level quit attempts. Purpose: Cost-effectiveness analysis was conducted in 2013 to evaluate Tips from a funding agency’s perspective. Methods: Estimates of sustained cessations; premature deaths averted; undiscounted life years (LYs) saved; and quality-adjusted life years (QALYs) gained by Tips were estimated. Results: Tips saved about 179,099 QALYs and prevented 17,109 premature deaths in the U.S. With the campaign cost of roughly $48 million, Tips spent approximately $480 per quitter, $2,819 per premature death averted, $393 per LY saved, and $268 per QALY gained. Conclusions: Tips was not only successful at reducing smoking-attributable morbidity and mortality but also was a highly cost-effective mass media intervention.
    American Journal of Preventive Medicine 12/2014;
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    ABSTRACT: Low-income and racial/ethnic minority populations experience disproportionate colorectal cancer (CRC) burden and poorer survival. Novel behavioral strategies are needed to improve screening rates in these groups. The study aimed to test a theoretically based "implementation intentions" intervention for improving CRC screening among unscreened adults in urban safety-net clinics. Randomized controlled trial. Adults (N=470) aged ≥50 years, due for CRC screening, from urban safety-net clinics were recruited. The intervention (conducted in 2009-2011) was delivered via touchscreen computers that tailored informational messages to decisional stage and screening barriers. The computer then randomized participants to generic health information on diet and exercise (Comparison group) or "implementation intentions" questions and planning (Experimental group) specific to the CRC screening test chosen (fecal immunochemical test or colonoscopy). The primary study outcome was completion of CRC screening at 26 weeks based on test reports (analysis conducted in 2012-2013). The study population had a mean age of 57 years and was 42% non-Hispanic African American, 28% non-Hispanic white, and 27% Hispanic. Those receiving the implementation intentions-based intervention had higher odds (AOR=1.83, 95% CI=1.23, 2.73) of completing CRC screening than the Comparison group. Those with higher self-efficacy for screening (AOR=1.57, 95% CI=1.03, 2.39), history of asthma (AOR=2.20, 95% CI=1.26, 3.84), no history of diabetes (AOR=1.86, 95% CI=1.21, 2.86), and reporting they had never heard that "cutting on cancer" makes it spread (AOR=1.78, 95% CI=1.16, 2.72) were more likely to complete CRC screening. The results of this study suggest that programs incorporating an implementation intentions approach can contribute to successful completion of CRC screening even among very low-income and diverse primary care populations. Future initiatives to reduce CRC incidence and mortality disparities may be able to employ implementation intentions in large-scale efforts to encourage screening and prevention behaviors. Copyright © 2014. Published by Elsevier Inc.
    American Journal of Preventive Medicine 12/2014; 47(6):703-14.
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    ABSTRACT: Background: Accidents are one of the leading causes of death among U.S. active-duty Army soldiers. Evidence-based approaches to injury prevention could be strengthened by adding person level characteristics (e.g., demographics) to risk models tested on diverse soldier samples studied over time. Purpose: To identify person-level risk indicators of accident deaths in Regular Army soldiers during a time frame of intense military operations, and to discriminate risk of not-line-of-duty from line-of-duty accident deaths. Methods: Administrative data acquired from multiple Army/Department of Defense sources for active duty Army soldiers during 2004-�2009 were analyzed in 2013. Logistic regression modeling was used to identify person-level sociodemographic, service-related, occupational, and mental health predictors of accident deaths. Results: Delayed rank progression or demotion and being male, unmarried, in a combat arms specialty, and of low rank/service length increased odds of accident death for enlisted soldiers. Unique to officers was high risk associated with aviation specialties. Accident death risk decreased over time for currently deployed, enlisted soldiers and increased for those never deployed. Mental health diagnosis was associated with risk only for previous and never-deployed, enlisted soldiers. Models did not discriminate not-line-of-duty from line of-duty accident deaths. Conclusions: Adding more refined person-level and situational risk indicators to current models could enhance understanding of accident death risk specific to soldier rank and deployment status. Stable predictors could help identify high risk of accident deaths in future cohorts of Regular Army soldiers.
    American Journal of Preventive Medicine 11/2014; 47(6):745.
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    ABSTRACT: Background Sitting time (ST), a form of sedentary behavior, has been identified as a highly prevalent risk factor for multiple sclerosis (MS)–related morbidity. There is limited information on the efficacy of behavioral interventions for reducing ST in persons with MS. Purpose To examine the efficacy of a behavioral intervention for reducing ST in persons with MS in a pilot RCT. Methods Seventy MS patients were randomly assigned to intervention and waitlist control conditions. The behavioral intervention was delivered April–September 2012 via the Internet and consisted of a dedicated website and one-on-one Skype video chats that taught participants the skills, techniques, and strategies for reducing sedentary behavior based on social cognitive theory. ST was measured by questions on the abbreviated International Physical Activity Questionnaire (IPAQ) before and after the 6-month RCT. Data were analyzed in SPSS, version 21.0 in March 2014. Results ANCOVA was performed on post-intervention scores controlling for pre-intervention values using an intent-to-treat analysis. The group main effect was statistically significant (F[1, 67]=4.03, p<0.05, η²=0.06) and yielded a parameter estimate of 98.9 (SE=49.3, t=2.01, p<0.05). The adjusted mean scores for intervention and control groups were 429.2 (201.2) and 528.2 (200.7) minutes of ST, respectively (d=0.49). Conclusion We provide the first data on the efficacy of a behavioral intervention for reducing ST in MS patients. This highlights the importance of designing and testing the effect of behavioral interventions that reduce ST on secondary outcomes such as function, symptoms, quality of life, and health status in persons with MS.
    American Journal of Preventive Medicine 11/2014;
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    ABSTRACT: Background Skin cancer prevention emphasizes early adoption and practice of sun protection behaviors. Adolescence represents a high-risk period for ultraviolet radiation exposure, presenting an opportunity for intervention. The ubiquity of mobile phones among teens offers an engaging medium through which to communicate prevention messages. Purpose To evaluate a skin cancer prevention intervention using short messaging service (SMS, or text messages) to impact sun-related knowledge, beliefs, and behaviors among adolescents. Methods The intervention was conducted in middle school youth (N=113) recruited in April or October 2012. Participants were English speakers, 11–14 years old, routinely carried a mobile phone, and completed a 55-minute sun safety education program. Participants were sent three sun safety–themed SMS messages each week for 12 weeks. Skin and sun protective knowledge, beliefs, behaviors, and post-intervention program satisfaction were collected and analyzed at baseline and end of intervention (April/June 2012; October 2012/January 2013). Paired responses were tested for equality using Wilcoxon signed-rank tests. Results Ninety-six students (85%) completed the study. At 12 weeks, significant positive changes were reported for sun avoidance during peak ultraviolet radiation, sunscreen application, wearing hats and sunglasses, and knowledge about skin cancer risk. Participants expressed moderately high satisfaction with the program, and 15% shared messages with family or friends. Conclusions A brief, SMS-based intervention affected youth skin cancer prevention behaviors and knowledge. Future research will determine whether program effects were sustained at 24 weeks and explore how sun safety parenting practices inform these effects.
    American Journal of Preventive Medicine 11/2014;
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    ABSTRACT: Background Sedentary behavior is regarded as a distinct risk factor for cardiometabolic morbidity and mortality, but knowledge of the efficacy of interventions targeting reductions in sedentary behavior is limited. Purpose To investigate the effect of an individualized face-to-face motivational counseling intervention aimed at reducing sitting time. Design A randomized, controlled, observer-blinded, community-based trial with two parallel groups using open-end randomization with 1:1 allocation. Setting/participants A total of 166 sedentary adults were consecutively recruited from the population-based Health2010 Study. Intervention Participants were randomized to a control (usual lifestyle) or intervention group with four individual theory-based counseling sessions. Main outcome measures Objectively measured overall sitting time (ActivPAL 3TM, 7 days); secondary measures were breaks in sitting time, anthropometric measures, and cardiometabolic biomarkers, assessed at baseline and after 6 months. Data were collected in 2010–2012 and analyzed in 2013–2014 using repeated measures multiple regression analyses. Results Ninety-three participants were randomized to the intervention group and 73 to the control group, and 149 completed the study. The intervention group had a mean sitting time decrease of –0.27 hours/day, corresponding to 2.9% of baseline sitting time (hours/day); the control group increased mean sitting time by 0.06 hours/day. The between-group difference in change, –0.32 hours/day (95% CI=–0.87, 0.24, p=0.26), was not statistically significant. Significant differences in change in fasting serum insulin of –5.9 pmol/L (95% CI=–11.4, –0.5, p=0.03); homeostasis model assessment–estimated insulin resistance of –0.28 (95% CI=–0.53, –0.03, p=0.03); and waist circumference of –1.42 cm (95% CI=–2.54, –0.29, p=0.01) were observed in favor of the intervention group. Conclusions Although the observed decrease in sitting time was not significant, a community-based, individually tailored, theory-based intervention program aimed at reducing sitting time may be effective for increasing standing and improving cardiometabolic health in sedentary adults. Trial registration This study is registered at (NCT00289237).
    American Journal of Preventive Medicine 11/2014;
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    ABSTRACT: Background Health insurance status affects access to preventive services. Effective use of preventive services is a key factor in the reduction of important health concerns and has the potential to enable adults to live longer, healthier lives. Purpose To analyze the use of U.S. Preventive Services Task Force (USPSTF)-recommended preventive services among uninsured adults, with a focus on variation across race, ethnicity, and household income. Methods Using pooled 2004–2011 Medical Expenditure Panel Survey data, this study conducted multivariate logistic regressions to estimate variation in receipt of eight USPSTF-recommended preventive services by race/ethnicity among adults aged 18 years and older uninsured in the previous year. Stratified analyses by household income were applied. Data were analyzed in 2013. Results Uninsured adults received preventive services far below Healthy People 2020 targets. Among the uninsured, African Americans had higher odds of receiving Pap tests, mammograms, routine physical checkups, and blood pressure checks according to guidelines than whites. Moreover, compared to whites, Hispanics had higher odds of receiving Pap tests, mammograms, influenza vaccinations, and routine physical checkups and lower odds of receiving blood pressure screening and advice to quit smoking. When results were stratified by household income, racial/ethnic differences persisted except for the highest income levels (≥400% Federal Poverty Level), where they were largely non-significant. Conclusions Generally, uninsured African American and Hispanic populations fare better than uninsured whites in preventive service utilization. Future research should examine reasons behind these racial/ethnic differences to inform policy interventions aiming to increase preventive service utilization among the uninsured.
    American Journal of Preventive Medicine 10/2014;
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    ABSTRACT: Background Type II diabetes (diabetes) and its complications can sometimes be prevented, if identified and treated early. One fifth of diabetics in the U.S. remain undiagnosed. Commonly used screening guidelines are inconsistent. Purpose To examine the optimal age cut-point for opportunistic universal screening, compared to targeted screening, which is recommended by U.S. Preventive Services Task Force (USPSTF) and American Diabetes Association (ADA) guidelines. Methods Cross-sectional analysis of a nationally representative sample from the National Health and Nutrition Examination Survey, 2007–2010. Number of people needed to screen (NNS) to obtain one positive test result was calculated for different guidelines. Sampling weights were applied to construct national estimates. The 2010 Medicare fee schedule was used for cost estimation. Analysis was conducted in January 2014. Results NNS, under universal screening, drops sharply at age 35 years, from 80 (30–34-year-olds) to 31 (35–39-year-olds). Opportunistic universal screening of eligible people aged ≥35 years would yield an NNS of 15, translating to $66 per positive test. Among people aged 35–44 years (who are not recommended for universal screening by ADA), most (71%) were overweight or obese and all had at least one other ADA risk factor. Only 34% of individuals aged ≥35 years met USPSTF criteria. Strictly enforcing USPSTF guidelines would have resulted in a majority (61%) of potential positive test cases being missed (5,508,164 cases nationwide). Conclusions Opportunistic universal screening among individuals aged ≥35 years could greatly reduce the national prevalence of undiagnosed pre-diabetes or diabetes at relatively low cost.
    American Journal of Preventive Medicine 10/2014;
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    ABSTRACT: Background How parent and sibling obesity status comparatively shape a child’s obesity is unknown. Purpose To investigate how the obesity status of different children within the same family is related to a parent or sibling’s obesity. Methods A national sample of adults in 10,244 American households was surveyed during 2011; data were analyzed in 2012–2013. Of these households, 1,948 adults had one or two children; provided sociodemographic information; and reported on adult and child height and weight, physical activity, and food environment. Logistic regression models were estimated in which the outcome of interest was child obesity status, with parent and sibling obesity as key predictors, adjusting for a range of both adult and child social and demographic confounders. Results In one-child households, it was 2.2 times more likely (SE=0.5) that the child would be obese if a parent was obese. In households with two children, having an obese younger sibling was more strongly associated with elder-child obesity (OR=5.4, SE=1.9) than parent’s obesity status (OR=2.3, SE=0.8). Having an obese elder sibling was associated with younger-child obesity (OR=5.6, SE=1.9), and parent obesity status was no longer significant. Within-family sibling obesity was more strongly patterned between siblings of the same gender than between different genders, and child physical activity was significantly associated with obesity status. Conclusions Considering offspring composition and sibling gender may be beneficial in childhood obesity prevention and intervention.
    American Journal of Preventive Medicine 10/2014;
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    ABSTRACT: In 2009, the U.S. Food and Drug Administration was required to mandate that graphic health warning labels be placed on cigarette packages and advertisements.
    American Journal of Preventive Medicine 09/2014;
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    ABSTRACT: Vaccination promotion strategies are recommended in Women, Infants, and Children (WIC) settings for eligible children at risk for under-immunization due to their low-income status.
    American Journal of Preventive Medicine 09/2014;
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    ABSTRACT: Background The Research Prioritization Task Force of the National Action Alliance for Suicide Prevention conducted a stakeholder survey including 716 respondents from 49 U.S. states and 18 foreign countries. Purpose To conduct a qualitative analysis on responses from individuals representing four main stakeholder groups: attempt and loss survivors, researchers, providers, and policy/administrators. This article focuses on a qualitative analysis of the early-round, open-ended responses collected in a modified online Delphi process, and, as an illustration of the research method, focuses on analysis of respondents’ views of the role of life and emotional skills in suicide prevention. Methods Content analysis was performed using both inductive and deductive code and category development and systematic qualitative methods. After the inductive coding was completed, the same data set was re-coded using the 12 Aspirational Goals (AGs) identified by the Delphi process. Results Codes and thematic categories produced from the inductive coding process were, in some cases, very similar or identical to the 12 AGs (i.e., those dealing with risk and protective factors, provider training, preventing reattempts, and stigma). Other codes highlighted areas that were not identified as important in the Delphi process (e.g., cultural/social factors of suicide, substance use). Conclusions Qualitative and mixed-methods research are essential to the future of suicide prevention work. By design, qualitative research is explorative and appropriate for complex, culturally embedded social issues such as suicide. Such research can be used to generate hypotheses for testing and, as in this analysis, illuminate areas that would be missed in an approach that imposed predetermined categories on data.
    American Journal of Preventive Medicine 09/2014; 47(3):S106–S114.
  • American Journal of Preventive Medicine 09/2014; 47(3):S102–S105.